Survival Medicine - Lifesavings Steps

Control panic, both your own and the victimís. Reassure him and try to
keep him quiet.

Perform a rapid physical exam. Look for the cause of the injury and follow
the ABCs of first aid, starting with the airway and breathing, but be
discerning. A person may die from arterial bleeding more quickly than
from an airway obstruction in some cases.

Open Airway and Maintain
You can open an airway and maintain it by using the following steps.

Step 1. Check if the victim has a partial or complete airway obstruction.
If he can cough or speak, allow him to clear the obstruction naturally.
Stand by, reassure the victim, and be ready to clear his airway and perform
mouth-to-mouth resuscitation should he become unconscious. If
his airway is completely obstructed, administer abdominal thrusts until
the obstruction is cleared.

Step 3. Using the jaw thrust method, grasp the angles of the victimís
lower jaw and lift with both hands, one on each side, moving the jaw
forward. For stability, rest your elbows on the surface on which the
victim is lying. If his lips are closed, gently open the lower lip with your
thumb (Figure 4-1).

Step 4. With the victimís airway open, pinch his nose closed with your
thumb and forefinger and blow two complete breaths into his lungs.
Allow the lungs to deflate after the second inflation and perform the
following:
- Look for his chest to rise and fall.
- Listen for escaping air during exhalation.
- Feel for flow of air on your cheek.

Step 5. If the forced breaths do not stimulate spontaneous breathing,
maintain the victimís breathing by performing mouth-to-mouth
resuscitation.

Step 6. There is danger of the victim vomiting during mouth-to-mouth
resuscitation. Check the victimís mouth periodically for vomit and clear
as needed.

Note: Cardiopulmonary resuscitation (CPR) may be necessary after cleaning
the airway, but only after major bleeding is under control. See FM 21-20, the American Heart Association manual, the Red Cross manual, or most other first aid books for detailed instructions on CPR.

Control Bleeding
In a survival situation, you must control serious bleeding immediately
because replacement fluids normally are not available and the victim can
die within a matter of minutes. External bleeding falls into the following classifications (according to its source):

- Arterial. Blood vessels called arteries carry blood away from the heart
and through the body. A cut artery issues bright red blood from the
wound in distinct spurts or pulses that correspond to the rhythm of
the heartbeat. Because the blood in the arteries is under high pressure,
an individual can lose a large volume of blood in a short period
when damage to an artery of significant size occurs. Therefore, arterial
bleeding is the most serious type of bleeding. If not controlled
promptly, it can be fatal.
- Venous. Venous blood is blood that is returning to the heart through
blood vessels called veins. A steady flow of dark red, maroon, or bluish
blood characterizes bleeding from a vein. You can usually control
venous bleeding more easily than arterial bleeding.
- Capillary. The capillaries are the extremely small vessels that connect
the arteries with the veins. Capillary bleeding most commonly occurs
in minor cuts and scrapes. This type of bleeding is not difficult to
control.

Direct Pressure
The most effective way to control external bleeding is by applying
pressure directly over the wound. This pressure must not only be firm
enough to stop the bleeding, but it must also be maintained long enough
to ďseal offĒ the damaged surface.

If bleeding continues after having applied direct pressure for 30 minutes,
apply a pressure dressing. This dressing consists of a thick dressing of
gauze or other suitable material applied directly over the wound and
held in place with a tightly wrapped bandage (Figure 4-2). It should be
tighter than an ordinary compression bandage but not so tight that it
impairs circulation to the rest of the limb. Once you apply the dressing,
do not remove it, even when the dressing becomes blood soaked.

Leave the pressure dressing in place for 1 or 2 days, after which you can
remove and replace it with a smaller dressing.

In the long-term survival environment, make fresh, daily dressing
changes and inspect for signs of infection.

Elevation
Raising an injured extremity as high as possible above the heartís level
slows blood loss by aiding the return of blood to the heart and lowering
the blood pressure at the wound. However, elevation alone will not
control bleeding entirely; you must also apply direct pressure over the
wound. When treating a snakebite, however, keep the extremity lower
than the heart.

Pressure Points
A pressure point is a location where the main artery to the wound lies
near the surface of the skin or where the artery passes directly over a
bony prominence (Figure 4-3). You can use digital pressure on a pressure
point to slow arterial bleeding until the application of a pressure
dressing. Pressure point control is not as effective for controlling bleeding
as direct pressure exerted on the wound. It is rare when a single
major compressible artery supplies a damaged vessel.
If you cannot remember the exact location of the pressure points, follow
this rule: Apply pressure at the end of the joint just above the injured
area. On hands, feet, and head, this will be the wrist, ankle, and neck,
respectively.

Maintain pressure points by placing a round stick in the joint, bending
the joint over the stick, and then keeping it tightly bent by lashing. By
using this method to maintain pressure, it frees your hands to work in
other areas.Digital Ligation
You can stop major bleeding immediately or slow it down by applying
pressure with a finger or two on the bleeding end of the vein or artery.
Maintain the pressure until the bleeding stops or slows down enough to
apply a pressure bandage, elevation, and so forth.

Tourniquet
Use a tourniquet only when direct pressure over the bleeding point and
all other methods did not control the bleeding. If you leave a tourniquet
in place too long, the damage to the tissues can progress to gangrene,
with a loss of the limb later. An improperly applied tourniquet can also
cause permanent damage to nerves and other tissues at the site of the
constriction.

If you must use a tourniquet, place it around the extremity, between the
wound and the heart, 5 to 10 centimeters above the wound site (Figure
4-4). Never place it directly over the wound or a fracture. Use a stick as
a handle to tighten the tourniquet and tighten it only enough to stop
blood flow. When you have tightened the tourniquet, bind the free end
of the stick to the limb to prevent unwinding.

After you secure the tourniquet, clean and bandage the wound. A lone
survivor does not remove or release an applied tourniquet. In a buddy
system, however, the buddy can release the tourniquet pressure every
10 to 15 minutes for 1 or 2 minutes to let blood flow to the rest of the
extremity to prevent limb loss.

Prevent and Treat Shock
Anticipate shock in all injured personnel. Treat all injured persons as
follows, regardless of what symptoms appear (Figure 4-5):

- If the victim is conscious, place him on a level surface with the lower
extremities elevated 15 to 20 centimeters.
- If the victim is unconscious, place him on his side or abdomen with
his head turned to one side to prevent choking on vomit, blood, or
other fluids.
- If you are unsure of the best position, place the victim perfectly flat.
Once the victim is in a shock position, do not move him.
- Maintain body heat by insulating the victim from the surroundings
and, in some instances, applying external heat.

- If wet, remove all the victimís wet clothing as soon as possible and
replace with dry clothing.
- Improvise a shelter to insulate the victim from the weather.
- Use warm liquids or foods, a prewarmed sleeping bag, another person,
warmed water in canteens, hot rocks wrapped in clothing, or
fires on either side of the victim to provide external warmth.
- If the victim is conscious, slowly administer small doses of a warm
salt or sugar solution, if available.
- If the victim is unconscious or has abdominal wounds, do not give
fluids by mouth.
- Have the victim rest for at least 24 hours.
- If you are a lone survivor, lie in a depression in the ground, behind a
tree, or any other place out of the weather, with your head lower
than your feet.
- If you are with a buddy, reassess your patient constantly.